• 昆明醫(yī)學(xué)院第二附屬醫(yī)院肝膽胰外科（昆明650101）;

目的 探討肝移植術(shù)后膽管并發(fā)癥發(fā)生的原因，就其預(yù)防、診斷和治療提出對策。
方法復(fù)習(xí)近年來國內(nèi)、外相關(guān)文獻(xiàn)并進(jìn)行綜述。
結(jié)果 肝移植術(shù)后膽管并發(fā)癥形成的原因相當(dāng)復(fù)雜，預(yù)防的方法目前還沒有統(tǒng)一的標(biāo)準(zhǔn)。治療措施根據(jù)其形成的原因不同而有所差別。
結(jié)論保存性損傷和缺血性損傷以及手術(shù)技術(shù)不佳和膽管的血液供應(yīng)不良都是肝移植術(shù)后發(fā)生膽管并發(fā)癥的重要原因。改進(jìn)T管置管方法可顯著降低與T管相關(guān)的膽管并發(fā)癥的發(fā)生率。膽道充分沖洗，盡量減少對供者膽管血供的損害以及實現(xiàn)精細(xì)膽管黏膜無張力對端吻合是預(yù)防膽系并發(fā)癥的關(guān)鍵。聯(lián)合應(yīng)用膽管造影技術(shù)和核磁共振膽胰管成像能了解膽樹全貌，有助于膽管狹窄、膽泥淤積與膽瘺的診斷，及時采用放射介入技術(shù)處理膽管并發(fā)癥可取得良好療效。

引用本文： 周健,李立. 肝移植術(shù)后膽管并發(fā)癥的預(yù)防與診治. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(3): 365-368. doi: 復(fù)制

1. Langenbecks Arch Chir Suppl Kongressbd， 1998; 115∶1560.
2. Gastroenterol Clin North Am， 1993; 22(2)∶317.
3. Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl， 2001; 7(11 Suppl 1)∶S46.
4. 鄭樹森， 徐曉， 吳健， 等. 原位肝移植后膽道并發(fā)癥的診斷與治療 [J]. 中華器官移植雜志， 2002； 23（3）∶154.
5. 陸敏強(qiáng), 陳規(guī)劃, 黃潔夫. 不同熱、 冷缺血時間對供肝膽道保存的影響 [J]. 中山醫(yī)科大學(xué)學(xué)報, 1998; 19(S1)∶18.
6. 陳規(guī)劃， 陸敏強(qiáng)， 何曉順， 等. 原位肝移植術(shù)后膽道并發(fā)癥的預(yù)防和診治 [J]. 中華外科雜志， 2003； 41（1）∶3.
7. SanchezUrdazpal L, Gores GJ, Ward EM, et al. Ischemictype biliary complications after orthotopic liver transplantation [J]. Hepatology, 1992； 16(1)∶49.
8. Langrehr JM, Schneller A, Neuhaus R, et al. Etiologic factors and incidence of ischemic type biliary lesions (ITBL) after liver transplantation [J].
9. Greif F, Bronsther OL, Thiel DHV, et al. The incidence, ti ming, and management of biliary tract complications after orthotopic liver transplantation [J]. Ann Surg, 1994； 219(1)∶40.
10. Margarit C, Hidalgo E, Lazaro JL, et al. Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients [J]. Transpl Int, 1998； 11(Suppl 1)∶S251.
11. Sankary HN, McChesney L, Frye E, et al. A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation [J]. Hepatology, 1995； 21(1)∶63.
12. Ostroff JW. Posttransplant biliary problems [J]. Gastrointest Endosc Clin N Am， 2001； 11(1)∶163.
13. 朱志軍, 張海明, 沈中陽， 等. 肝移植術(shù)后非吻合口膽管狹窄相關(guān)危險因素的研究 [J]. 中華肝膽外科雜志， 2004； 10（8）∶552.
14. Grewal HP, ShokouhAmiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with ducttoduct biliary reconstruction [J]. Ann Surg, 2001； 233(4)∶502.
15. 方善德, 曹繡虎，主編. 膽道外科的理論與實踐 [M]. 第1版. 鄭州: 河南科學(xué)技術(shù)出版社, 1991∶7~8.
16. Randall HB, Wachs ME, Somberg KA, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2) ∶258.
17. Donovan J. Nonsurgical management of biliary tract disease after liver transplantation [J].
18. Rouch D, Emond J, Mayes J, et al. Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver [J]. Surg Gynecol Obstet, 1990； 170(3)∶239.
19. Randell H, Wachs M, Somberg K, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2)∶258.
20. Scatton O, Meunier B, Cherqui D, et al. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation [J]. Ann Surg, 2001； 233(3)∶432.
21. Park J S, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003； 57(1)∶78.
22. Sawyer RG, Punch JD. Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting [J]. Transplantation, 1998； 66(9)∶1201.
23. 嚴(yán)律南, 李波, 盧實春， 等. 原位肝移植術(shù)后近期并發(fā)癥的防治 [J]. 臨床外科雜志， 2002； 10（6）∶333.
24. O’Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation [J]. Arch Surg, 1995； 130(3)∶312.
25. Turrion VS, Alvira L G, Jimenez M, et al. Management of the biliary complications associated with liver transplantation: 13 years of experience [J]. Transplant Proc, 1999； 31(6)∶2392.
26. 汪根樹, 陳規(guī)劃, 何曉順， 等. 原位肝移植術(shù)后膽漏的診斷和治療 [J]. 中華普通外科雜志， 2004； 19（12）∶713.
27. Krawczyk M, Nyckowski P, Zieniewicz K, et al. Biliary complications following liver transplantation [J]. Transplant Proc, 2000； 32(6)∶1429.
  1. 1. Langenbecks Arch Chir Suppl Kongressbd， 1998; 115∶1560.
  2. 2. Gastroenterol Clin North Am， 1993; 22(2)∶317.
  3. 3. Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl， 2001; 7(11 Suppl 1)∶S46.
  4. 4. 鄭樹森， 徐曉， 吳健， 等. 原位肝移植后膽道并發(fā)癥的診斷與治療 [J]. 中華器官移植雜志， 2002； 23（3）∶154.
  5. 5. 陸敏強(qiáng), 陳規(guī)劃, 黃潔夫. 不同熱、 冷缺血時間對供肝膽道保存的影響 [J]. 中山醫(yī)科大學(xué)學(xué)報, 1998; 19(S1)∶18.
  6. 6. 陳規(guī)劃， 陸敏強(qiáng)， 何曉順， 等. 原位肝移植術(shù)后膽道并發(fā)癥的預(yù)防和診治 [J]. 中華外科雜志， 2003； 41（1）∶3.
  7. 7. SanchezUrdazpal L, Gores GJ, Ward EM, et al. Ischemictype biliary complications after orthotopic liver transplantation [J]. Hepatology, 1992； 16(1)∶49.
  8. 8. Langrehr JM, Schneller A, Neuhaus R, et al. Etiologic factors and incidence of ischemic type biliary lesions (ITBL) after liver transplantation [J].
  9. 9. Greif F, Bronsther OL, Thiel DHV, et al. The incidence, ti ming, and management of biliary tract complications after orthotopic liver transplantation [J]. Ann Surg, 1994； 219(1)∶40.
  10. 10. Margarit C, Hidalgo E, Lazaro JL, et al. Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients [J]. Transpl Int, 1998； 11(Suppl 1)∶S251.
  11. 11. Sankary HN, McChesney L, Frye E, et al. A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation [J]. Hepatology, 1995； 21(1)∶63.
  12. 12. Ostroff JW. Posttransplant biliary problems [J]. Gastrointest Endosc Clin N Am， 2001； 11(1)∶163.
  13. 13. 朱志軍, 張海明, 沈中陽， 等. 肝移植術(shù)后非吻合口膽管狹窄相關(guān)危險因素的研究 [J]. 中華肝膽外科雜志， 2004； 10（8）∶552.
  14. 14. Grewal HP, ShokouhAmiri MH, Vera S, et al. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with ducttoduct biliary reconstruction [J]. Ann Surg, 2001； 233(4)∶502.
  15. 15. 方善德, 曹繡虎，主編. 膽道外科的理論與實踐 [M]. 第1版. 鄭州: 河南科學(xué)技術(shù)出版社, 1991∶7~8.
  16. 16. Randall HB, Wachs ME, Somberg KA, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2) ∶258.
  17. 17. Donovan J. Nonsurgical management of biliary tract disease after liver transplantation [J].
  18. 18. Rouch D, Emond J, Mayes J, et al. Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver [J]. Surg Gynecol Obstet, 1990； 170(3)∶239.
  19. 19. Randell H, Wachs M, Somberg K, et al. The use of the T tube after orthotopic liver transplantation [J]. Transplantation, 1996； 61(2)∶258.
  20. 20. Scatton O, Meunier B, Cherqui D, et al. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation [J]. Ann Surg, 2001； 233(3)∶432.
  21. 21. Park J S, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003； 57(1)∶78.
  22. 22. Sawyer RG, Punch JD. Incidence and management of biliary complications after 291 liver transplants following the introduction of transcystic stenting [J]. Transplantation, 1998； 66(9)∶1201.
  23. 23. 嚴(yán)律南, 李波, 盧實春， 等. 原位肝移植術(shù)后近期并發(fā)癥的防治 [J]. 臨床外科雜志， 2002； 10（6）∶333.
  24. 24. O’Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation [J]. Arch Surg, 1995； 130(3)∶312.
  25. 25. Turrion VS, Alvira L G, Jimenez M, et al. Management of the biliary complications associated with liver transplantation: 13 years of experience [J]. Transplant Proc, 1999； 31(6)∶2392.
  26. 26. 汪根樹, 陳規(guī)劃, 何曉順， 等. 原位肝移植術(shù)后膽漏的診斷和治療 [J]. 中華普通外科雜志， 2004； 19（12）∶713.
  27. 27. Krawczyk M, Nyckowski P, Zieniewicz K, et al. Biliary complications following liver transplantation [J]. Transplant Proc, 2000； 32(6)∶1429.